Journal article
The economic consequences of available diagnostic and prognostic strategies for the evaluation of stable angina patients: an observational assessment of the value of precatheterization ischemia
Journal of the American College of Cardiology, v 33(3), pp 661-669
01 Mar 1999
PMID: 10080466
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
OBJECTIVES
The study aim was to determine observational differences in costs of care by the coronary disease diagnostic test modality.
BACKGROUND
A number of diagnostic strategies are available with few data to compare the cost implications of the initial test choice.
METHODS
We prospectively enrolled 11,372 consecutive stable angina patients who were referred for stress myocardial perfusion tomography or cardiac catheterization. Stress imaging patients were matched by their pretest clinical risk of coronary disease to a series of patients referred to cardiac catheterization. Composite 3-year costs of care were compared for two patients management strategies: 1) direct cardiac catheterization (aggressive) and 2) initial stress myocardial perfusion tomography and selective catheterization of high risk patients (conservative). Analysis of variance techniques were used to compare costs, adjusting for treatment propensity and pretest risk.
RESULTS
Observational comparisons of aggressive as compared with conservative testing strategies reveal that costs of care were higher for direct cardiac catheterization in all clinical risk subsets (range: $2,878 to $4,579), as compared with stress myocardial perfusion imaging plus selective catheterization (range: $2,387 to $3,010, p < 0.0001). Coronary revascularization rates were higher for low, intermediate and high risk direct catheterization patients as compared with the initial stress perfusion imaging cohort (13% to 50%, p < 0.0001); cardiac death or myocardial infarction rates were similar (p > 0.20).
CONCLUSIONS
Observational assessments reveal that stable chest pain patients who undergo a more aggressive diagnostic strategy have higher diagnostic costs and greater rates of intervention and follow-up costs. Cost differences may reflect a diminished necessity for resource consumption for patients with normal test results.
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Details
- Title
- The economic consequences of available diagnostic and prognostic strategies for the evaluation of stable angina patients: an observational assessment of the value of precatheterization ischemia
- Creators
- Leslee J. Shaw - Emory UniversityRory Hachamovitch - Cornell UniversityDaniel S. Berman - Cedars-Sinai Medical CenterThomas H. Marwick - Cleveland ClinicMichael S. Lauer - Cleveland ClinicGary V. Heller - Institute for Community LivingAmi E. Iskandrian - Cedars-Sinai Medical CenterKaren L. Kesler - Duke UniversityMark I. Travin - Roger Williams Medical CenterHoward C. Lewin - Cedars-Sinai Medical CenterRobert C. Hendel - Northwestern UniversitySalvador Borges-Neto - Duke UniversityD.Douglas Miller - Saint Louis Universityfor the Economics of Noninvasive Diagnosis (END) Multicenter Study GroupDavid Donovan Miller - Antoinette Westphal College of Media Arts and Design (2005-)
- Publication Details
- Journal of the American College of Cardiology, v 33(3), pp 661-669
- Publisher
- Elsevier
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Antoinette Westphal College of Media Arts and Design
- Web of Science ID
- WOS:000079179400011
- Scopus ID
- 2-s2.0-0033101527
- Other Identifier
- 991019169791504721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems